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静脉静脉外体膜氧化过程中的抗血素与肝素抗凝:一个单中心队列研究

Bethany A Hileman¹, Gennaro Martucci², Nicolò Rizzitello³

¹University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

|June 4, 2024

概括

在静脉静脉外体膜氧化 (VV ECMO) 期间接受非分离氨酸 (UFH) 的患者中,较高的抗血素 (AT) 活性与更好的ICU存活率有关. 这项研究发现,在高AT水平的出血事件中没有显著差异.

科学领域:

关键护理医学关键护理医学
血液学血液学血液学
药理学药理学是指药理学的学科.

背景情况:

抗血素 (AT) 是一种重要的天然抗凝剂,可增强未分离氨酸 (UFH) 的疗效.
在静脉静脉外体膜氧化 (VV ECMO) 中基于UFH的抗凝剂中补充AT具有强大的病理生理基础.
保持足够的AT活性对于VVECMO患者有效的抗凝药至关重要.

研究的目的:

调查成年VVECMO患者的抗血素 (AT) 活性和未分离肝素 (UFH) 需求之间的关联.
评估AT活动水平与重症监护室 (ICU) 生存结果之间的关系.
为了在不同的AT活动亚群中比较抗凝管理和出血事件率.

主要方法:

一个单一中心的回顾性队列研究,涉及244名成年VV ECMO患者.
用UFH进行抗凝治疗,向40-50秒的激活部分血栓形成时间 (aPTT) 和AT活性>80%.
使用线性和逻辑回归分析来评估AT活动变化及其与ICU存活率的相关性.

主要成果:

患者的中位数UFH剂量为11.4 IU/kg/h,平均aPTT为46.1秒,平均AT活性为88.9%.
较高的AT活性与较低的平均aPTT相关,增加了UFH剂量,减少了没有UFH的时间.
在更高的AT活性和改善的ICU存活率之间观察到一个显著的关联 (或死亡率:每10%的AT增加0.95).

结论:

在AT活性和UFH要求之间存在正相关性,但出血事件没有显著增加.
在VV ECMO期间平均AT活性升高与加强ICU存活率独立相关.
需要进一步的研究来区分外源性AT补充与内源性AT水平对结果的影响.

关键词:

这是一种抗凝血药物.抗血素是一种抗血素.流血出血流血出血身体外膜氧化氧化肝素是一种肝素.

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